Pediatric IBD Patients on Combo Therapy Face Higher Skin Infection Risk

Study finds children with Crohn's disease on TNF-alpha inhibitors plus immunomodulators more likely to develop skin and soft tissue infections.

Feb. 2, 2026 at 5:31am

Got story updates? Submit your updates here. ›

A retrospective study of 264 pediatric patients with inflammatory bowel disease (IBD) found that those receiving combination therapy with a tumor necrosis factor-alpha (TNF-alpha) inhibitor and an immunomodulator were more likely to develop skin and soft tissue infections, especially those with Crohn's disease. The type of TNF-alpha inhibitor (adalimumab or infliximab) did not significantly affect infection rates.

Why it matters

This study highlights the increased risk of skin and soft tissue infections in pediatric IBD patients, particularly those with Crohn's disease, when receiving combination biologic and immunomodulator therapy. Understanding these safety patterns can help clinicians better counsel patients and make informed treatment decisions.

The details

Researchers reviewed data on 264 pediatric IBD patients, including 209 with Crohn's disease, 52 with ulcerative colitis, and 3 with unclassified IBD. They compared outcomes between those receiving a TNF-alpha inhibitor alone (n=249) and those receiving combination therapy with immunomodulators (n=15). All 15 patients on combination therapy developed a skin or soft tissue infection, compared to 15.3% (38/249) of those on TNF-alpha inhibitor monotherapy. Skin and soft tissue infections were more common in Crohn's disease patients (23%) than in those with ulcerative colitis (7.7%).

  • The study period was from January 2012 to June 2022.

The players

Jordan Kahle

A co-lead author of the study and a physician at Case Western Reserve University School of Medicine in Cleveland.

Hailey Seibert

A co-lead author of the study and a physician at Case Western Reserve University School of Medicine in Cleveland.

Got photos? Submit your photos here. ›

What they’re saying

“Pediatric patients with CD, particularly those receiving combination therapy, are at greatest risk for skin and soft tissue infections while on anti-TNF-alpha therapy.”

— Jordan Kahle and Hailey Seibert, Study authors (Journal of the American Academy of Dermatology)

What’s next

The researchers noted that the development of skin and soft tissue infections did not significantly impact overall IBD management, but stated that 'awareness of these patterns is essential to guide timely recognition, collaborative care, and appropriate treatment decisions' by dermatologists.

The takeaway

This study highlights the increased risk of skin and soft tissue infections in pediatric IBD patients, especially those with Crohn's disease, when receiving combination biologic and immunomodulator therapy. Clinicians should be vigilant in monitoring for these infections and work collaboratively with dermatologists to provide appropriate care.